KNEE JOINT ANATOMY

(Kevin Ongeti, Beda Olabu & Kirsteen O. Awori)

4.1 INTRODUCTION
The knee joint is the articulation between distal femur, proximal tibia and the patella. It is the
largest joint in the body, classified as compound synovial joint of condylar (tibiofemoral) and
saddle (patellofemoral) varieties. It is considered a modified hinge joint since it can
accommodate some degrees of rotation, to a limited extend.

4.2 CHAPTER OBJECTIVES

1. To describe the articular surfaces of the knee joint.
2. To describe the stability factors of the knee joint.
3. To describe the muscular and neurovascular relations of the knee joint.
4. To describe the movements of the knee joint.

4.3 OSTEOLOGY OF THE KNEE

You will look at the anatomy of the distal femur, proximal tibia and the patella

4.3.1 OSTEOLOGY OF THE DISTAL FEMUR

Study the anatomy of the distal femur once again and take note of the following:
 The distal end of the femur consists of two condyles, the medial and lateral condyles
and separated by an intercondylar notch.

Task 4.1

Study the two femoral condyles and state which condyle:

a) Is wider transversely
b) Has a longer antero-posterior tibial articular surface
c) Is more curved
d) Has a more prominent buttress
e) Groove for insertion of the tendon of popliteus muscle
  Identify the patellar surface of femur and note that the lateral patellar surface has a
larger surface area, and is more raised, than the medial patellar surface. This is one of
the stability mechanisms of the patella.
 Identify the epicondyles which are above each condyle. The medial epicondyle is
more prominent than the lateral epicondyle, and forms the attachment of the
hamstring component of the adductor magnus muscle. The lateral epicondyle is the
attachment of the fibula collateral ligament.
 The intercondylar notch has attachment sites of the anterior and posterior cruciate
ligaments. The anterior cruciate ligament attaches on the posteromedial aspect of the
lateral condyle, while the posterior cruciate attaches on the anterolateral aspect of the
medial condyle. Identify these sites on the bony specimen provided.
 Identify the supracondylar lines which extend from each condyle proximally, to
merge with the corresponding lips of the linear aspera.
Use the anatomy of the distal femur you have studied to side the femur bones available to
you.

4.3.2 OSTEOLOGY OF THE PATELLA

The patella is a sesamoid bone which develops between ages 3 to 6 years after birth from 3 to
six cartilaginous parts along the tendon of the quadriceps pull. In rare occasions those parts
fail to fuse forming a bipartite or tripartite patella.

Study the anatomy of the patella as you take note of the following:
 The base of the patella is superior while the apex faces inferiorly.
 It has two surfaces, the posterior smooth articular surface, while the non-articular
surface is rough and anterior.
 A vertical ridge that separates the medial from the lateral articular surfaces. The
medial articular surface is smaller than the lateral articular surface.

With these features in mind, attempt to side the patella you have on the table, and any other
that may be available for you, until you master the concept.
An easier and simpler way of siding the bone is to place it on a flat surface with shinny
articular surface facing downwards and the apex pointing away from you. Note that it will
always fall on its side!
4.3.3 OSTEOLOGY OF THE PROXIMAL TIBIA
The proximal tibia is widened and form the lateral and medial tibial condyles, with each
condyle having a relatively flat superior surface termed the tibial plateau. The region between
the medial and lateral tibial plateau is the intercondylar eminence. Note the following
regarding the proximal tibia:
 The lateral articular surface is almost circular, with a shorter anteroposterior axis.
 The medial articular surface is oval with a longer anteroposterior axis.
 The differences in the anatomy of the medial and lateral tibial plateau are reflected in
the shapes of the menisci that lie on them. If a wet specimen is available, check to
confirm the structure of the corresponding menisci. In the absence of a wet specimen,
check the attachments of the menisci in the atlas of Anatomy.

Task 4.2
State the following regarding the knee menisci:
a) Histological structure

b) Gross anatomical differences between the medial and lateral menisci

c) Pattern of blood supply to the meniscus and its clinical relevance

d) Functions of the knee menisci

  Identify the following parts of the intercondylar eminence:
o Anterior intercondylar area, which forms the distal attachment of the
anterior cruciate ligament
o Posterior intercondylar area, which forms the distal attachment of the
posterior cruciate ligament
o Intercondylar tubercles, that form the attachments of the anterior and
posterior cornu of the menisci.
 The tibial tuberosity is a projection in the proximal anterior tibial shaft. It forms the
insertion of the patella tendon.

Use the anatomy of the proximal tibia you have studied to side tibial bones available to you.

4.4 KNEE JOINT CAPSULE & LIGAMENTS

The knee joint capsule is best appreciated from a wet specimen. In the absence of one, use
your atlases to note the following:
 The capsule attaches proximally to the margins of the articular surface of the femoral
condyles and the intercondylar area. Anteriorly the capsule is attached to the patella
retinacula, blending all the way to the ligamentum patella. The patella ligament
extends from the apex of the patella to the tibial tuberosity.
 Medial and lateral collateral ligaments are visible on either side of the joint. The
medial collateral ligament is flat and triangular and extends from medial femoral
condyle just distal to the adductor tubercle to the proximal medial tibia. Assess the
lateral collateral ligament which is a cord like band extending from lateral epicondyle
below the origin of the lateral head of gastrocnemius to the head of the fibula.

Task 4.3

Study the key function of each of the collateral ligaments of the knee.

Discuss the role of the medial patellofemoral ligament in patella stability

 The oblique popliteal ligament is a posterior capsular reinforcement in the floor of
the popliteal fossa, as an extension of the tendon of the semimembranosus insertion.
 Appreciate the presence of the arcuate popliteal ligament, which is Y shaped
thickening of the capsule. The stem of this ligament originates from the head of the
fibula, with its fibers arching over the tendon of popliteus muscle to the intercondylar
region of the tibia.
 Note the presence of intra capsular ligaments namely the anterior and posterior
cruciate ligaments. The anterior cruciate ligament is attached to the anterior
intercondylar region of the tibia, extending to the posteromedial aspect of the lateral
femoral condyle. The posterior cruciate ligament crosses from the posterior
intercondylar region to the anteromedial aspect of the medial femoral condyle. The
two ligaments cross each other in the intercondylar region in a cruciform manner.

Task 4.4

State the following for each of the cruciate ligaments:

(a) Attachments/foot prints

(b) Course/orientation within the knee joint

(c) Bundle anatomy

(d) Blood supply

(e) Functions
Task 4.5
Complete the anatomy of the knee joint by discussing the following questions in your
groups:
(e) Static stability factors

(f) Dynamic stability factors

(g) Bursae around the knee and the clinical relevance of some of them

(h) Pattern of blood supply to the knee joint & surgical relevance: including
approaches to and design of common flaps around.

(i) Muscular and neurovascular relations of the knee joint

(j) Movements of the knee joint and the muscles responsible for each